MEDICARE: DR. SONJA TERRY VAN LAAR PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	18404	CA
2	103T00000X	Psychologist	PY11919	FL

General Provider Information

NPI Number	:	1982764874
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SONJA TERRY VAN LAAR PH.D.

Provider Business Mailing Address
First Line	:	15544 W COLONIAL DR
Second Line	:
City	:	WINTER GARDEN
State	:	FL
Zip	:	34787-9556
Country	:	US
Telephone Number	:	800-457-4573
Fax Number	:	800-443-6422

Provider Business Practice Location Address
First Line	:	1504 KINGS HWY UNIT 300
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33980-5240
Country	:	US
Telephone Number	:	800-457-4573
Fax Number	:	800-443-6422

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/11/2006
Last Update Date	:	10/27/2025

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